Das Moumita, Angeli Federica, Krumeich Anja J S M, van Schayck Onno C P
School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
Institute for Social and Economic Change (ISEC), Bangalore, India.
BMC Int Health Hum Rights. 2018 Jan 16;18(1):3. doi: 10.1186/s12914-018-0142-x.
Slum dwellers display specific traits when it comes to disclosing their illnesses to professionals. The resulting actions lead to poor health-seeking behaviour and underutilisation of existing formal health facilities. The ways that slum people use to communicate their feelings about illness, the type of confidants that they choose, and the supportive and unsupportive social and cultural interactions to which they are exposed have not yet been studied in the Indian context, which constitutes an important knowledge gap for Indian policymakers and practitioners alike. To that end, this study examines the patterns of illness disclosure in Indian slums and the underpinning factors which shape the slum dwellers' disclosing attitude.
In-depth, semi-structured interviews were conducted among 105 men and 113 women who experienced illness in the year prior to the study period. Respondents were selected from four urban slums in two Indian cities, Bangalore and Kolkata.
Findings indicate that women have more confidants at different social levels, while men have a limited network of disclosures which is culturally and socially mediated. Gender role limitations, exclusion from peer groups and unsupportive local situations are the major cause of disclosure delay or non-disclosure among men, while the main concerns for women are a lack of proper knowledge about illness, unsupportive responses received from other people on certain occasions, the fear of social stigma, material loss and the burden of the local situation. Prompt sharing of illness among men is linked with prevention intention and coping with biological problems, whereas factors determining disclosure for women relate to ensuring emotional and instrumental safety, preventing collateral damage of illness, and preventing and managing biological complications.
The findings reveal that patterns of disclosure are not determined by the acknowledgment of illness but largely depend on the interplay between individual agency, disclosure consequences and the socio cultural environment. The results of this study can contribute significantly to mitigating the pivotal knowledge gap between health policymakers, practitioners and patients, leading to the formulation of policies that maximise the utilisation of health facilities in slums.
在向专业人员透露病情方面，贫民窟居民表现出特定的特点。这些行为导致了不良的就医行为以及对现有正规医疗设施的利用不足。在印度的背景下，贫民窟居民用于表达对疾病感受的方式、他们选择的知己类型以及他们所经历的支持性和非支持性的社会文化互动尚未得到研究，这对印度政策制定者和从业者来说都是一个重要的知识空白。为此，本研究考察了印度贫民窟中疾病披露的模式以及塑造贫民窟居民披露态度的潜在因素。
对在研究期前一年患病的105名男性和113名女性进行了深入的半结构化访谈。受访者从印度班加罗尔和加尔各答两个城市的四个城市贫民窟中选取。
研究结果表明，女性在不同社会层面有更多知己，而男性的披露网络有限，且受到文化和社会的影响。性别角色限制、被同龄人排斥以及不利的当地环境是男性延迟披露或不披露病情的主要原因，而女性主要担心的是对疾病缺乏正确认识、在某些情况下从他人那里得到的不利回应、对社会耻辱的恐惧、物质损失以及当地环境的负担。男性之间迅速分享病情与预防意图和应对生理问题有关，而决定女性披露病情的因素则与确保情感和工具性安全、防止疾病的附带损害以及预防和处理生理并发症有关。
研究结果表明，披露模式并非由对疾病的认知决定，而是在很大程度上取决于个体能动性、披露后果和社会文化环境之间的相互作用。本研究结果可极大地有助于缩小卫生政策制定者、从业者和患者之间关键的知识差距，从而制定出能最大限度利用贫民窟医疗设施的政策。
